苏北农村居民就医行为分析

通过对苏北农村居民就医行为进行实地调查,分析影响其行为的原因,以期得出农村居民就医行为的主观意义和现实意义.对比农村居民就医行为的主观意义内生出的医疗保障制度与政府设置的外生的医疗保障制度--新型农村合作医疗制度,认为现存的新型农村合作医疗不能完全符合农村居民就医的主观要求,并从医疗保障制度调适的角度,提出新型农村合作医疗制度完善的途径.     

新农合对高血压患者就医行为和费用影响

目的:通过2010年的横断面调查,探讨新型农村合作医疗制度对于农村高血压患者就医行为和就医费用的影响。方法:采取多阶段分层随机抽样方法,在山东省8个县随机抽取了6 216名25周岁以上的农村居民进行家庭健康问卷调查。采用Logistic回归和广义线性回归分析了4个新型农村合作医疗制度变量的影响。结果:享受高血压补偿政策和即时报销政策的患者倾向于前往更低层次的医疗机构就诊;门诊报销比例高导致高血压患者就诊费用升高(P=0.080),而享受高血压补偿政策导致费用下降(P=0.005)。结论:新型农村合作医疗制度中针对高血压制定相关补偿政策和报销政策,可以改善患者的就医行为,减轻患者的经济负担。     

农村居民慢性病患者卫生服务利用的公平性研究

为进一步了解农村居民慢性病患者卫生服务利用的公平情况,通过对农村居民慢性病患者卫生服务的利用情况进行调查发现,因经济困难未治疗和未住院的慢性病患者比例随收入的降低而呈升高的趋势,并且不同收入组的慢性病患者自付费用也呈现出较明显的不公平性。在新型农村合作医疗制度完善的过程中,应该为低收入人群慢性病患者提供保障卫生服务利用的措施。     

新型农村合作医疗制度下农村居民门诊就医行为分析

[目的]分析新型农村合作医疗制度下农村居民的门诊就医行为,发现问题并提出解决对策。[方法]应用?2检验和有序logistic回归模型对参合农民的就医行为进行统计分析。[结果]55.82%的农村居民生病后选择找医生看病;在就诊的患者中,选择村卫生室和乡镇卫生院的比例占86.16%,其最主要原因是距离近和方便;学历较高和非农业劳动者患病后更倾向于选择较高级别的医疗机构就诊。[结论]应适当提高门诊的补偿水平,逐步拓宽门诊的补偿范围,加强对农村卫生机构的建设。     

赣州市新型农村合作医疗建设现状与思考

新型农村合作医疗制度是改善居民就医问题的一项基本医疗保障制度,对于改善农村居民的健康状况,推进新农村建设有着重要的历史意义,该文通过对赣州市新型农村合作医疗建设现状的分析,提出改进意见,进一步推进地区新农村建设和新农合的全面实施与可持续发展。     

农村居民就医行为的地区差异及其原因调查分析

目前农民仍然是我国人口的主体,农民的健康问题影响到国民身体素质的提高,因此,建立新型农村合作医疗制度对中国农村发展有着非常重要的战略意义。纵观建国以来农村合作医疗制度的发展历程,这项制度的推行可谓一波三折。新型农村合作医疗制度虽然在农村得到了普遍的推广,但这项社会政策能否持续发展下去,关键在于能否满足农村居民的就医需求,是否与农民的就医行为特征相契合。笔者通过对经济社会发展水平差异明显的南通、     

新型农村合作医疗门诊补偿方案对居民就诊机构选择影响研究

目的:调查农村居民门诊就诊机构现状,分析新型农村合作医疗门诊统筹补偿方案对其影响,为完善方案设计提供参考依据。方法:采用定量与定性相结合的研究方法;通过问卷调查法,对6 024位农村居民进行了入户调查;通过文献法,收集相关政策文件,了解被调查地区门诊补偿方案设计现状。结果:被调查地区门诊补偿均为门诊统筹模式,具体补偿方案不尽相同;被调查居民门诊就诊机构以村级和乡镇级医疗机构为主,主要原因为距离近和新型农村合作医疗能给予补偿;基层医疗机构门诊补偿比例是农村居民选择门诊就诊机构影响因素之一。结论:被调查地区农村居民门诊主要选择在基层医疗机构就诊,新型农村合作医疗补偿比例是其选择机构的一个重要影响因素。因此,应逐步提高新型农村合作医疗门诊补偿水平,并对基层医疗机构设置较高补偿比例。     

农村慢性病病人家庭的疾病经济风险分析

当前，慢性病正在成为危害农村居民健康和生命的主要卫生问题，慢性病的疾病经济负担也成为农村居民因病致贫的主要诱因之一。因此，新型农村合作医疗制度对慢性病门诊费用的补偿方式与程度，对减轻农村居民经济负担具有重要影响，也是影响新型农村合作医疗可持续发展的重要因素。山东大学卫生管理与政策研究中心尹爱田等在对山东、甘肃两省抽样调查基础上，分析了农村慢性病病人家庭的疾病经济风险，探讨了慢性病门诊费用纳入新型农村合作医疗大病统筹基金管理的必要性。同时，通过对慢性病病种的筛选、人均筹资增加额的测算，论证了慢性病门诊费用纳入新型农村合作医疗大病统筹基金管理的可行性。最后，提出了慢性病纳入后的管理模式和策略。现将他们的研究成果一起奉上。供大家讨论和参考。[编者按]     

新型农村合作医疗对农村居民卫生服务利用公平性的影响研究

运用标化的定量分析方法,对云南省三个新型农村合作医疗试点县和三个非试点县农村居民卫生服务利用公平状况进行了量化对比分析。结果显示,新型农村合作医疗制度的实施在一定程度上改善了农村居民卫生服务利用的公平性,特别是在改善农村居民住院服务利用和住院费用负担公平方面作用更为突出。但是,由于新型农村合作医疗保障水平还比较低,其作用有限,应加强定点医疗机构医药费用控制,保障新型农村合作医疗制度良好发展。     

农村居民慢性病费用纳入新农合基金管理的模式研究

为进一步将慢性病费用科学的纳入新型农村合作医疗基金管理,文章对其必要性和可行性进行了深入分析。研究发现,强化新型农村合作医疗对慢性病的管理是非常必要的,而且通过筹资水平的不断提高,进一步将慢性病费用纳入新型农村合作医疗的基金管理也是可行的。建议通过建立慢性病保障基金等方式加强对慢性病患者的补偿,并通过建立健康档案对慢性病患者进行分级管理。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.